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SGLT2 and DPP4 inhibitors improve Alzheimer’s disease–like pathology and cognitive function through distinct mechanisms in a T2D–AD mouse model - 11/11/23

Doi : 10.1016/j.biopha.2023.115755 
A Young Sim a, b, 1 , Da Hyun Choi c, d, e, 1 , Jong Youl Kim a , Eun Ran Kim c, A-ra Goh a, b , Yong-ho Lee c, d, e, , Jong Eun Lee a, b, f,
a Department of Anatomy, Yonsei University College of Medicine, Seoul, Republic of Korea 
b Graduate School of Medical Science, Brain Korea 21 Project, Yonsei University College of Medicine, Seoul, Republic of Korea 
c Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea 
d Department of Systems Biology, Glycosylation Network Research Center, Yonsei University, Seoul, Republic of Korea 
e Interdisciplinary Program of Integrated OMICS for Biomedical Science, Yonsei University, Seoul, Republic of Korea 
f Brain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea 

Corresponding author at: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.Department of Internal Medicine, Yonsei University College of MedicineSeoulRepublic of Korea.⁎⁎Corresponding author at: Department of Anatomy, Yonsei University College of Medicine, Seoul, Republic of Korea.Department of Anatomy, Yonsei University College of MedicineSeoulRepublic of Korea.

Abstract

Alzheimer’s disease (AD) and type 2 diabetes mellitus (T2D) share common features, including insulin resistance. Brain insulin resistance has been implicated as a key factor in the pathogenesis of AD. Recent studies have demonstrated that anti-diabetic drugs sodium–glucose cotransporter-2 inhibitor (SGLT2-i) and dipeptidyl peptidase-4 inhibitor (DPP4-i) improve insulin sensitivity and provide neuroprotection. However, the effects of these two inhibitors on the brain metabolism and insulin resistance remain uninvestigated. We developed a T2D–AD mouse model using a high-fat diet (HFD) for 19 weeks along with a single dose of streptozotocin (100 mg/kg, intraperitoneally) at the fourth week of HFD initiation. Subsequently, the animals were treated with SGLT2-i (empagliflozin, 25 mg/kg/day orally [p.o.]) and DPP4-i (sitagliptin, 100 mg/kg/day p.o.) for 7 weeks. Subsequently, behavioral tests were performed, and the expression of insulin signaling, AD-related, and other signaling pathway proteins in the brain were examined. T2D–AD mice not only showed increased blood glucose levels and body weight but also insulin resistance. SGLT2-i and DPP4-i effectively ameliorated insulin sensitivity and reduced body weight in these mice. Furthermore, SGLT2-i and DPP4-i significantly improved hippocampal-dependent learning, memory, and cognitive functions in the T2D–AD mouse model. Interestingly, SGLT2-i and DPP4-i reduced the hyperphosphorylated tau (pTau) levels and amyloid β (Aβ) accumulation and enhanced brain insulin signaling. SGLT2-i reduced pTau accumulation through the angiotensin converting enzyme-2/angiotensin (1−7)/ mitochondrial assembly receptor axis, whereas DPP4-i reduced Aβ accumulation by increasing insulin-degrading enzyme levels. These findings suggest that SGLT2-i and DPP4-i prevent AD-like pathology and cognitive dysfunction in T2D mice potentially through affecting brain insulin signaling via different mechanisms.

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Highlights

SGLT2-i and DPP4-i improve peripheral and brain insulin signaling in T2D-AD mouse model induced with HFD and STZ.
SGLT2-i and DPP4-i reduce AD-related proteins in the brain and improve cognitive functions.
SGLT2-i reduces pTau by activating ACE2/MasR signaling pathway.
DPP4-i decreases Aβ accumulation by increasing IDE.

Le texte complet de cet article est disponible en PDF.

Abbreviations : AD, , pTau, NFTs, T2D, SGLT2-i, BG, DPP4-i, GLP-1, HFD, STZ, ND, i.p., BW, p.o., ITT, GTT, HOMA-IR, NORT, MWM, WB, IHC, PBS, CTX, HIPP, PFA, BSA, IRS1, pIRS1, Akt, pAkt, GSK3β, pGSK3β, ACE2, Ang1–7, MasR, IDE, TBS, H&E, qPCR, RAS, ACE1, Ang I, Ang II, AT1R, AT2R, fAD, sAD

Keywords : Alzheimer’s disease, Type 2 diabetes mellitus, Sodium–glucose cotransporter-2 inhibitor, Dipeptidyl peptidase-4 inhibitor, Hyperphosphorylated tau, Amyloid β


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